Date of Award

Spring 2020

Degree Name

Master of Medical Science (Physician Assistant)

Department

Physician Assistant; College of Health Sciences

First Advisor

Shannon Diallo

Abstract

Introduction: Multiple Sclerosis (MS) is an inflammatory demyelination disease of the central nervous system that results in debilitating symptoms such as muscle spasms, muscle stiffness, loss of coordination, change and loss in sensation, change in bowel and bladder function, and vision loss. It can take four different disease pathways and can progress at different rates, but all will eventually disable the patient. Medication can be used for acute flare-ups, but when it comes to maintenance or progression therapy, there is very little to offer MS patients. Physical therapy has proven to help maintain muscle strength, but there are limitations to its benefits, as there is no evidence that it will improve muscle weakness or spasticity. Therefore this review will analyze the use of electrical stimulation in combination with physical therapy and pose the question; In patients between the ages of 20 and 60 with progressive multiple sclerosis (P), does the use of functional electrical stimulation in conjunction with physical therapy (I) reduce established gait impairment (O) better than physical therapy alone (C)?

Methods: A literature search was conducted using the online databases PubMed, Google Scholar, and EBSCO in November 2018. A total of six articles were found, five consisting of randomized control trials and one utilizing a cohort study. They were selected based on sample population, intervention therapy, and publication date. The articles were then analyzed and compared.

Results: Using six different outcome measurements to assess gait function, each study showed that a statistically significant improvement was seen in at least one of the six categories. Three of the six studies looked at functional electrical stimulation (FES) in addition to physical exercise as an intervention, and three of the studies looked at FES versus physical exercise as intervention.

Discussion: Statistically significant improvements were seen in each of the six studies, but across multiple different outcome measures. The study designs each had weaknesses, such as small sample sizes, short study lengths, and lack of long term follow up. These weaknesses make it impossible to prove the efficacy of FES in symptomatic treatment of MS. There were no negative impacts of FES found among these studies.

Conclusion: Looking at this specific compilation of research, it proves that FES has the potential to provide relief for those experiencing gait alterations as a result of their MS diagnosis. Many positive outcomes were noted, but this is not enough to confidently state that FES should be used as a standard of treatment as the study designs were imperfect. With this said, its acute results cannot be ignored and should be considered by providers who are devising treatment plans for those MS patients who have been experiencing the debilitating effects of their disease. Further investigation of the long-term effects of FES should be investigated, as it could be indicated for more than acute treatment.

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Efficacy of Functional Electrical Stimulation in the context of combination therapy for treatment of gait impairment in patients with Multiple Sclerosis

Introduction: Multiple Sclerosis (MS) is an inflammatory demyelination disease of the central nervous system that results in debilitating symptoms such as muscle spasms, muscle stiffness, loss of coordination, change and loss in sensation, change in bowel and bladder function, and vision loss. It can take four different disease pathways and can progress at different rates, but all will eventually disable the patient. Medication can be used for acute flare-ups, but when it comes to maintenance or progression therapy, there is very little to offer MS patients. Physical therapy has proven to help maintain muscle strength, but there are limitations to its benefits, as there is no evidence that it will improve muscle weakness or spasticity. Therefore this review will analyze the use of electrical stimulation in combination with physical therapy and pose the question; In patients between the ages of 20 and 60 with progressive multiple sclerosis (P), does the use of functional electrical stimulation in conjunction with physical therapy (I) reduce established gait impairment (O) better than physical therapy alone (C)?

Methods: A literature search was conducted using the online databases PubMed, Google Scholar, and EBSCO in November 2018. A total of six articles were found, five consisting of randomized control trials and one utilizing a cohort study. They were selected based on sample population, intervention therapy, and publication date. The articles were then analyzed and compared.

Results: Using six different outcome measurements to assess gait function, each study showed that a statistically significant improvement was seen in at least one of the six categories. Three of the six studies looked at functional electrical stimulation (FES) in addition to physical exercise as an intervention, and three of the studies looked at FES versus physical exercise as intervention.

Discussion: Statistically significant improvements were seen in each of the six studies, but across multiple different outcome measures. The study designs each had weaknesses, such as small sample sizes, short study lengths, and lack of long term follow up. These weaknesses make it impossible to prove the efficacy of FES in symptomatic treatment of MS. There were no negative impacts of FES found among these studies.

Conclusion: Looking at this specific compilation of research, it proves that FES has the potential to provide relief for those experiencing gait alterations as a result of their MS diagnosis. Many positive outcomes were noted, but this is not enough to confidently state that FES should be used as a standard of treatment as the study designs were imperfect. With this said, its acute results cannot be ignored and should be considered by providers who are devising treatment plans for those MS patients who have been experiencing the debilitating effects of their disease. Further investigation of the long-term effects of FES should be investigated, as it could be indicated for more than acute treatment.

 
 

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